How much will insurance cost Missourians on new exchange?

Nov. 3, 2013

Becky Supak

Written by

Supak, 63, who has had blood clots, is one of the people the Affordable Care Act is supposed to help. She’s had insurance through Missouri’s high-risk pool because until Jan. 1, insurance companies can legally reject people like her to hold down their risk.

That high-risk pool is being closed. Supak said she was told that her monthly premiums of about $650 could rise by about $400 to $1,043 if she buys through the online marketplace and keeps coverage similar to what she now has with the same doctors.

“I’m in shock,” said Supak, who works as a Realtor.

About 7 million people nationwide are projected to buy insurance through the state and federal exchanges this year, according to the Congressional Budget Office. For many, the Affordable Care Act will mean they can buy coverage for the first time.

But insurance brokers and others say insurance companies are limiting choice on provider networks and raising prices as federal mandates prevent them from excluding people previously considered too risky to insure. The health care law also sets minimum standards for policies. All health insurance must offer 10 essential benefits including emergency care, maternity care and hospitalization coverage.

“For people who are typically insured, we’re finding that health care reform is not working very well for them,” said Richard Ollis, a Springfield insurance broker. “The plans are typically more limited and more expensive.”

A 27-year-old in Greene County would pay about $151 a month for the cheapest bronze plan from Coventry, according to a federal database of the prices. The cheapest bronze Anthem plan for a 27-year-old in Greene County is about $213 a month.

A 50-year-old in Greene County would pay about $257 a month for Coventry coverage and about $363 for Anthem under the cheapest bronze plans available. For a family of four, those prices would be about $509 from Coventry and $720 from Anthem. The family of four was calculated using two 30-year-old adults.

Deb Wiethop, a spokeswoman for Anthem, said consumers look at more than the prices.

“Similar plans with cheaper premiums often have higher co-pay and deductibles,” Wiethop said. “It’s also important to look at what benefits are offered and to understand that we are creating rates that are designed to be sustainable long term.”

The most expensive plans available in Greene County, gold plans, pay for 80 percent of covered medical costs. There are also platinum plans, which cover 90 percent of costs, but none are being sold in Missouri. In Greene County, a 27-year-old would pay about $222 for a gold plan from Coventry and about $356 for a gold plan from Anthem, according to the federal database. The cost for a 50-year-old would be about $378 and $607. A family of four would pay about $749 and $1,203.

Federal subsidies will help pay for the insurance for people who make up to $45,960 or $94,200 for a family of four. About 48 percent of people who buy individual policies are expected to be eligible for subsidies and would receive an average annual subsidy of $5,548, according to the Kaiser Family Foundation in Menlo Park, Calif.

(Page 3 of 4)

People don’t have to buy insurance through the exchange, but they can’t get subsidies if they buy plans that aren’t offered through the state and federal exchanges.

Springfield insurance plans have typically been split between plans that cover doctors affiliated with CoxHealth and doctors affiliated with Mercy. The plans available under the ACA in Greene County continue that. The Anthem plans being sold in Greene County cover CoxHealth, and Mercy is a network provider for Coventry plans.

“Anthem Blue Cross/Blue Shield has an exclusive agreement with CoxHealth in the Springfield area and with Freeman in Joplin,” said Sonya Kullmann, a spokeswoman for Mercy. “In all other areas, such as Carthage, Lebanon and Mountain View, Mercy is in-network on the Anthem plans. All of our locations are in-network for Coventry.”

Ollis summarized benefit coverage from Anthem and Coventry. Anthem won’t cover hospitalization at Mercy in Greene County except in an emergency. Coventry will pay for benefits at Cox, but consumers will have to pay more. People in Coventry on a family plan could pay up to $20,000 out-of-pocket if they go outside their network on a gold plan or up to $44,000 on one of the bronze plans.

Ozarks Community Hospital can accept both Anthem and Coventry, said hospital spokeswoman Andrea Harp. The hospital contracts with Cox for access to the Anthem products.

Anjie Coplin, a spokeswoman for Aetna, which owns Coventry, said defining what doctors and hospitals an insurance company will pay for “is one of the main opportunities for us to help control the cost of care and offer a competitively priced product.”

“Therefore, we have created networks for our exchange offerings that feature narrower networks with a subset of the hospitals and affiliated providers,” Coplin said.

The average prices in Missouri are comparable to the average prices for the 36 states where people are buying health insurance on the federal exchange, according to filings compiled by federal health officials.

(Page 4 of 4)

But only four other states where people are buying insurance through the federal exchange have less choice than Missouri residents, according to the filings. Those states are Alabama, New Hampshire, West Virginia and Wyoming. The average number of plans offered is 53, compared to 17 in Missouri.

Jay Angoff, the former Missouri insurance commissioner who went on to oversee the federal unit implementing the exchanges, questioned why there is less choice in Missouri.

“A cynic would argue that they’re waiting for the exchanges to fail, but that’s too cynical,” said Angoff, who now works for a Washington law firm.

Angoff said insurance companies may be waiting it out in Missouri in the expectation that people who are in the worst health will be buying insurance now. In the second year, the pool of people looking to buy insurance may be healthier, meaning less risk for the insurance companies that start selling policies on the exchange after the initial year.

Supak, the woman who was trying to buy insurance on the exchange, doesn’t qualify for the federal subsidies, so she decided to see what was available in the regular market. She called CoxHealth and was quoted a monthly premium of $700, similar to what she’s paying now, with a $1,500 deductible.